So who is ‘extremely vulnerable’ and should be shielding?

On 16 March, ITV reported the Chief Medical Officer for England saying that advice would shortly be sent out to ‘vulnerable’ people who should be taking extra steps to protect themselves against COVID-19, namely by shielding themselves for twelve weeks. He specifically stated that this would broadly speaking be those advised to have the annual flu vaccine:

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The Times the next day published this handy chart on what you should do if you were in a specific group:

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The Times table, obviously based on Government briefing, introduced the concept of ‘serious underlying health conditions’ which was clearly intended to be different from ‘underlying health condition’.

Those adults advised to have the flu vaccine include:

Screenshot 2020-03-30 at 12.24.31

Ok, now bear with me. I’ve been looking for up-to-date figures on the numbers getting the flu vaccination annually. Public Health England said 25 million were eligible for free flu vaccinations in 2019. In the previous year about 70% of over 65s took up the vaccination; and 48% of those in an at-risk group and 45% of pregnant women in England. This meant about 7.5 million over-65s had the vaccination; 6.8 million of those in at risk groups. In Wales, a total estimated 868,668 people were vaccinated.

So if the 16 March definition given by Professor Whitty had been used, then many millions of people would have been asked to shield themselves. Shielding, remember means this ‘You are strongly advised to stay at home at all times and avoid any face-to-face contact‘. Any face-to-face contact. In more detail:

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The extract above is from the Guidance issued by the UK Government on 21 March on shielding people defined as ‘extremely vulnerable’.

Those defined as ‘extremely vulnerable’ are clearly a much smaller group than the vulnerable groups mentioned by Professor Whitty on 16 March. They are defined as:

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As an asthmatic, I looked for definitions of ‘severe asthma’. Last Monday, 23 March, I found guidance issued by Asthma UK following advice from the Department of Health and Social Care in the UK. This suggested severe asthma consisted in the following:

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The original guidance posted by Asthma UK suggested ‘a high daily steroid dose’ meant – for example – two puffs a day of the Seretide inhaler, which is my own prescription. (for those definitions, see for example this). I would not have defined my asthma as ‘severe’ before reading that – I cycle regularly and feel my asthma is under good control.

The NHS Digital Clinical algorithm used to identify ‘Shielded patients’ however defines severe asthma as follows: ‘Severe asthmatics are those who are frequently prescribed high dose steroid tablets.’ (in the small print, this includes for example prednisolone.I haven’t been prescribed that for over 40 years, after I had been hospitalised for my asthma). This is of course different from the Asthma UK guidance on what is meant by severe asthma, a term which Asthma UK accepts is open to interpretation.

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In the detailed explanation of the NHS Clinical Algorithm, you will find the following:

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So 19 Million people would have been captured by Professor Whitty’s original suggestion of the vulnerable who should be shielded: these are now classified as ‘at risk’. Now there is a group of ‘at high risk’ people amounting to 1.5 million. These ‘at risk’ and ‘at high risk’ groups roughly correspond to the ‘vulnerable’ and ‘extremely vulnerable’ categories. It is the ‘at high risk’ or ‘extremely vulnerable’ group that have been getting letters and in some cases texts from the NHS as announced last Monday. Letters should have been received by today if you are ‘extremely vulnerable’.

If you think you should be in the ‘extremely vulnerable’ or ‘at high risk’ group but have not been categorised as such, then if you live in England you can log in here to say so. The option to challenge your categorisation may exist in Wales but if it does I can’t find it in this.

19 million at risk or vulnerable. 1.5 million ‘at high risk’ or ‘extremely vulnerable’. To my mind, this just reinforces the lack of clarity in government messaging over the last fortnight.

 

 

Coronavirus Curriculum Planning 2020-1

This is essentially me thinking aloud about the four post-grad modules I am scheduled to teach next academic year. Two weeks ago I said that if I was still here in the autumn – and I am planning to be:

Whatever happens, if I am here in the autumn, I will I know be teaching the social, political and economic consequences of coronavirus on at least two postgrad courses I lead.

In fact, I now think I will be teaching it on all four modules. All my teaching, aside from guest lectures, is in the October-January period, so I need to start some outline preparation. Here goes as I brain-dump some initial course thinking in a public value business school.

Government from the Inside – From the Minister’s Viewpoint (PLT435)

You can find a link to the module overview here. It is essentially an overview of the Ministerial life, from appointment to leaving office. It looks amongst other things at Appointment and the first 100 days, Ministers in Cabinet, as departmental leaders, in the Chamber and Committee, working with and against the Opposition, Ministers and the Media, pressure groups and ministers, evidence for ministerial policy-making, leaving ministerial office. It covers UK and devolved ministerial life.I am planning a book for Palgrave Macmillan based on the course which I have now taught for the last three years.

Students are assessed through an end-of-term essay. These are on topics they choose and are always interesting. Last year one student elected to look at Norman Fowler and the Aids Crisis, which has some parallels with today’s crisis. If I took a coronavirus lens I guess I would look through the course at how the virus has disrupted the marking of Boris Johnson’s 100 days in office; how COBR (A) has worked in co-ordination, including with the devolved administrations, how scrutiny of evidence has developed in Parliamentary committees, how pressure group and media criticism has influenced ministerial policy, and the role of daily press briefings in crises, the collation of evidence in an emerging crisis and the building of ministerial discursive capacity, Opposition input in the crisis, and maybe some futurism about ministerial reputations in the crisis and their likely scorecards after leaving office.

I am already collating materials, from press reports to parliamentary inquiries and government documents, which includes much of the advice that went to SAGE. (To be fair to the UK government, a lot of material has been published in respect of the evidence base and their assumptions). There is also a considerable amount of material on managing crises in the interviews with former ministers on the Institute for Government’s Ministers Reflect series. No question then that coronavirus will feature on this module.

International Business Management (BST448)

This is one of the core modules on Cardiff Business School’s MSc. in International Management. I have been teaching this module for the last two years and it has had a significant ‘tech’ focus, which has enabled the exploration of themes around globalisation, based on my recent research. In postgrad terms it’s a large module with about 140 students, a very high proportion of them from China. Who knows how or if this will change next year? The COVID-19 outbreak has sparked all kinds of writing about the future of globalisation, networks, re-localisation, etc. The COVID-19 outbreak also lends itself to a straightforward introduction for management students to PESTLE analysis.

There are significant opportunities here obviously to look comparatively at governmental and political responses, business impacts in different sectors, the role of technology in surveillance of the disease (and obviously surveillance more generally), and how the disease may affect international business development, including global value chains. It may allow students to bring their own country by country observations to the forefront.

Think I will definitely be teaching COVID-19 and its impact on the the global economy this course, but it may require some re-writing.

Leading Policy and Delivery (BST652)

I was involved in co-developing our new part-time MSc in Public Leadership . This autumn I will be teaching the module about leading policy into delivery over three sessions. I guess that COVID-19 will become one of the cases that we will interrogate as it will be directly relevant to everyone’s immediate experience. Our students come from a variety of public service backgrounds.

Unlike the ministerial module above, the focus will be more about the impact on public service delivery. So I can see us covering its impact on the relationship between the making of policy and its implementation on the ground; thefeedback loops between frontline delivery and policy-making; collaboration between services,  both devolved and non-devolved; integration of third sector in delivery; what this means for target-setting, capacity- building, resilience planning, governance.

Much of this would have been discussed on the module in any case. But there is quite a lot to plan for here. And I think the agenda will expand as time goes by.

Strategic Planning and Innovation (BST680).

This year we began teaching a postgraduate Diploma in Healthcare  Planning in Wales. I am one of two academics teaching on the Strategic Planning and Innovation module. To a degree, our emphasis, as the NHS Wales Deputy Chief Executive, Simon Dean, said at Cardiff Business School in 2019, is that what matters most is the planning, not the plan. Though this was devised before the COVID-19 outbreak, we already had considered planning for unexpected emergencies and crises and ways in which governments did this in a variety of spheres, from terrorist outbreaks to a no-deal Brexit. COVID-19 forces consideration of previous planning exercises for pandemics.

This module from my perspective probably needs some adjustment but less overall than the others, as the key themes are there in outline, but need drawing out with reference to the current crisis, and the evidence materials published by the UK Government already mentioned above are directly relevant.

That was a brain-dump on behalf of my course planning. Now I need to allocate time for teaching preparation for each of these modules.

 

Coronavirus – Living well is the best revenge

As a 62 year-old asthmatic with ropey lungs I have been apprehensive about Coronavirus for some weeks, and the news from Italy over the last week or so intensified my worries.

Today, one conference at which I was to give a paper in April (Political Studies Association in Edinburgh) has been cancelled. Last week their expressed view was that they were going ahead. Cardiff University has now taken the decision on the other one where I was due to give a paper out of my hands – PUPOL in The Hague at Leiden University –, saying ‘all work-related travel outside the UK should be postponed until further notice unless it is essential.’ I suspect PUPOL would have been cancelled anyway.

We are waiting on the UK government’s decisions over closures and further social distancing. Obviously Ireland made its decision to close schools etc today. Yesterday, Denmark, where our son lives, took that decision.

My 90 year old mother has been in and out of hospital over the last four weeks, so that has been my main concern as I have been visiting her in hospital, and when she was out last week there were a series of medical and care calls to undertake, before she went back in on Sunday.

My mother’s care and the need to visit her in hospital means that I cannot do what Colin Talbot has done and self-isolate, or ‘cocoon’ as Colin prefers, but from what I know of Colin’s medical conditions they are much more serious than mine. But I have been giving active consideration to that, given the way COVID-19 targets the lungs. We haven’t been stockpiling toilet rolls but our cupboards and freezer have the necessary basics to avoid shopping if we had to. Today I noticed local shop-keepers wearing plastic gloves and using sanitiser after customers touched card machines and counters, and who can blame them.

We also have childcare responsibilities with our grand-children – days spent with them are a bonus to life.

I am currently due to give a lecture on Monday to 2-300 students as a guest lecturer on another course, but there is no reason why the materials couldn’t be delivered on-line, and that is the same case with a guest lecture the following week to a smaller number.

The charity I chair, the Cardiff City Community Foundation, has its annual Foundation year events over the weekend starting tomorrow, as we celebrate how Our Club Changes Lives. We have been reviewing all our activities – and our risks – over the last week in the context of the advice from Public Health Wales.

This is a year in which we were lucky enough to have a concentrated period of holidays in May and June – a wedding in Spain, an educational visit to Sicily, and then the Euros in Rome for which we are fortunate enough to have tickets. How many of these will now go ahead is anyone’s guess. UEFA is meeting to discuss whether the Euros are postponed for a year apparently.

Whatever happens, if I am here in the autumn, I will I know be teaching the social, political and economic consequences of coronavirus on at least two postgrad courses I lead.

If I am here in the autumn. I plan to be, but the truth is no-one knows what outcomes will be. I am sick of hearing about people who have died being described as elderly or having ‘underlying health conditions’. Every coronavirus death is a tragedy. No-one should be dehumanised and no death simply excused away as due to the individual being ‘elderly’ or having ‘underlying health conditions’. I have underlying health conditions. So do millions.

We are living with uncertainty, in a way that few of my generation and those younger have ever experienced. Indeed maybe only those with experience of living through the war have anything similar to compare it with.

I think the advice from the UK government will now change to a more intensified set of social distancing recommendations every few days. I have confidence in the scientists, but I am keeping an eye on what is being said in Italy in particular.

The declared number of cases is not the true number of cases, as the scientists said today. 500+ cases officially in the UK, but more like 5-10,000 in the population as a whole, and they are no longer going to be testing cases in the community, but keeping testing for those in hospital already.

They are, without saying it, planning for the worst, and unlike with swine flu and avian flu, where preparations were made for the worst case, we have practical evidence in Europe of what that worst case looks like.

Regulating Facebook

I was interviewed a couple of weeks back by the Belgian newspaper De Standaard as to how Facebook might be regulated. You can find the article here. I tried out a couple of ideas I am thinking about for the book for Routledge that I am currently working on.

Alternatively, if you don’t speak Dutch (nor do I!), the translation is below:

After the Cambridge Analytica scandal, the last few days there have been calls to  regulate Facebook. But how do you do that?

Dominique Deckmyn
Europe already has a lot of rules and regulations that restrict Facebook. And of course Facebook will also be subject to the GDPR, the new privacy legislation that will come into force at the end of May. Europe also wants internet companies to act more quickly against hate messages. And there is the controversial proposal to impose a special tax on the turnover of large internet companies.

“It’s patchwork,” says Leighton Andrews, a professor at Cardiff University and a senior manager at the BBC and minister in the Wales Regional Government. He is one of the academics who have made proposals in recent years for a real legal framework for the internet giants Facebook and Google. ‘This is a new kind of business, so we also have to regulate it in a new way.’

Medium or utility?

Many in the media sector see Facebook and Google as competitors, and would like to see that they are considered media companies. That would impose clearer obligations on them when passing on news reports. But Andrews and others think that you should compare Facebook with a public utility such as electricity, water, or telephone. “Because of the enormous scale and power of Facebook and Google, no one will ever build a new Facebook or a new Google,” says Andrews. ‘De facto they are a utility company. A piece of essential social infrastructure. And most countries regulate their essential infrastructure.’

Andrews calls Facebook a utility company of a new order: an information utility. This must be supervised by a specialized regulator. He compares the situation with the moment that the British telecom giant BT was privatized. In order to avoid BT becoming too powerful, it was stipulated, among other things, that it was not allowed to venture onto the TV market.

In the same way, Facebook could be forbidden to develop certain activities. Or could thresholds be defined – such as: how many percent of the advertising market can the company get?

According to Andrews, Facebook should also report on a regular basis to a special regulator, as the telecom in our country is regulated by the BIPT and the media in Flanders by the VRM.

Transparency

Two American authors, David Gunton and Justin Hendrix, presented a somewhat less far-reaching model last week, with an emphasis on transparency. “We propose that Facebook should register as a social media platform and report publicly every quarter,” Gunton, a lecturer at the University of Georgia, summarizes via e-mail. ‘Among other things about their privacy practices. The public can then decide informed, and perhaps Facebook will behave better ‘. Gunton and Hendrix propose that the existing market regulator FTC exert control.

In the report that Facebook should submit, a signed statement from CEO Mark Zuckerberg should also state that his company complies with legal obligations. The social networks should also open up their computer systems to external researchers, so that they can check whether all rules are being respected. Gunton and Hendrix believe that the US also need its own privacy legislation ‘based on the European’.

Self-regulation

The big internet companies have always maintained that they can keep themselves under control – self-regulation, no laws was the motto. After the Cambridge Analytica scandal, Zuckerberg suddenly said he was not against regulation. He knows from where the wind blows. ‘The question is rather what the right regulation is’, he added in a recent interview. He explicitly referred to the Honest Ads Act, the bill that states that Facebook must disclose who paid for a political advertisement. Now that Zuckerberg has been called on the floor at the American Congress, chances are that there will be far more far-reaching proposals.

Break apart

But can we allow companies such as Facebook, Google, Amazon and Apple to exist in their current form? The American professor Scott Galloway, author of the book The Four, thinks that because of their enormous power, they stifle the functioning of the free market, and that they have to be split up. According to Galloway, Facebook has to be divided into three companies: Instagram, Whatsapp and the social network Facebook. He has for the time being few supporters, but it is not out of the blue: telecom giant AT & T was once divided, and Microsoft barely escaped it in 1999.

The American antitrust think tank The Open Markets Institute goes one step further in an opinion piece in The Guardian: Facebook’s advertising department also has to become a separate company. And on top of that, the US must enforce strict privacy rules. Remarkable: The Open Markets Institute is also pushing the GDPR, the new European privacy legislation, forward as an example for the US.